Optimizing evidence-based HIV prevention targeting people who inject drugs on PrEP

以多阶段优化战略(MOST)为框架，并建立在我们最新的 初步研究，我们正在请求5年的支持，以进行优化试验 注射毒品者(PWID)和新登记的阿片类药物使用障碍患者 (Moud)。目标是评估四个干预部分的性能(注意， 执行功能、记忆和信息处理)旨在增强 PWID on Moud处理和利用循证艾滋病毒预防内容，导致 改进暴露前预防措施(PrEP)的遵守情况，降低艾滋病毒风险。现有 循证干预要求参与者至少有中等水平的认知能力 功能正常，但不承认或容纳认知障碍的参与者。 这是一个关键的弱点，因为认知功能障碍是PWID的共同特征，也是 这会直接阻碍他们处理和利用干预内容的能力。事实上，我们的 最近比较客观和自我报告认知评估的研究(例如，NIH工具箱) 显示约67%的PWID经历了大量的跨任务认知功能障碍 涉及注意力、执行功能、记忆和信息处理，反过来， 破坏预期的干预结果(例如，坚持用药、降低艾滋病毒风险)。 我们最近的工作还表明，新加入Moud的PWID将受益于 采用“补偿策略”的干预方法，以适应他们 认知功能障碍。一些行之有效的补偿策略是 成功应用于其他患者群体(例如创伤性脑损伤、ADHD、 阿尔茨海默氏症/痴呆症)，并被我们的团队确定为有希望的干预措施 可加强以循证为基础、以PrEP为重点的艾滋病毒初级预防的组成部分 针对Moud上的PWID的方法。然而，到目前为止，还没有研究检查 单独或合并此类干预组件的潜在影响和成本 在各种组合中，在增强PWID处理和利用艾滋病毒的能力方面 预防内容。这一创新的试验将是第一次使用MOST框架来优化 一种基于证据的艾滋病毒预防方法，通过补偿以下认知特征来实现 Moud上的PWID特征，并在真实世界中最大化PrEP遵守结果 预算限制。

Framed by the multiphase optimization strategy (MOST), and building on our recent preliminary studies, we are requesting 5 years of support to conduct an optimization trial among people who inject drugs (PWID) and newly enrolled on medication for opioid use disorder (MOUD). The goal is to assess the performance of four intervention components (Attention, Executive Functioning, Memory, and Information Processing) aimed at enhancing the ability of PWID on MOUD to process and utilize evidence-based HIV prevention content, leading to improvements in Pre-Exposure Prophylaxis (PrEP) adherence and HIV risk reduction. Existing evidence-based interventions require participants to have at least moderate levels of cognitive functioning but do not acknowledge or accommodate participants with cognitive dysfunction. This is a crucial weakness as cognitive dysfunction is a common feature among PWID, and one that can directly impede their ability to process and utilize intervention content. In fact, our recent studies comparing objective and self-report cognitive assessments (e.g., NIH toolbox) show that ~67% of PWID experience substantial levels of cognitive dysfunction across tasks involving attention, executive function, memory, and information processing that, in turn, disrupt the expected intervention outcomes (e.g., medication adherence, HIV risk reduction). Our recent work also suggests that PWID newly enrolled on MOUD would benefit from an intervention approach that incorporates ‘compensatory strategies’ to accommodate their cognitive dysfunction. A number of well-established compensatory strategies have been successfully applied to other patient populations (e.g., traumatic brain injury, ADHD, Alzheimer’s/dementia) and have been identified by our team as promising intervention components that could enhance evidence-based PrEP-focused primary HIV prevention approaches targeting PWID on MOUD. To date, however, no studies have examined the potential impact and cost of incorporating such intervention components, either individually or in various combinations, in terms of enhancing PWID’s ability to process and utilize HIV prevention content. This innovative trial will be the first to use the MOST framework to optimize an evidence-based HIV prevention approach by compensating for cognitive features that are characteristic of PWID on MOUD, and maximizing PrEP adherence outcomes within real world budget constraints.